The purpose of our proposed study is to examine the effectiveness and cost-effectiveness of a smoking- cessation intervention for patients at two urban hospitals. The population of hospitalized patients has a higher prevalence of current smoking than the general population (especially among psychiatric patients); hospitalization represents a time of enforced abstinence and a window of opportunity to get patients motivated and engaged in improving their health. These two hospitals serve primarily low-income communities, where there are particularly high rates of smoking and many barriers to receiving high-quality health cai'e and achieving good health care outcomes. During hospitalization, all enrolled smokers will receive usual care plus brief telephone counseling via an in- hospital connection to the state telephone Quitline. At the time of discharge, patients will be randomized to one of two arms: multisession telephone counseling by their hospital's smoking cessation staff, or faxed referral to the New York State Smokers' Quitline. All patients will receive appropriate nicotine replacement therapy. We hypothesize that the enhanced post-discharge intervention (i.e. telephone counseling by local counselors) will result in greater 12-month smoking abstinence rates than the faxed referral to the state Quitline. Our primary outcome will be smoking abstinence rate (biochemically verified) at 12 months post-discharge. We plan to compare the effectiveness and the cost-effectiveness of these two interventions. Secondary aims will involve explorations of differences in effectiveness in specific patient subgroups, and examination of smoking abstinence outcomes at 3-months and 6-months post-discharge.